| NPI | 1720278021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101005363) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801014952) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2007-08-01 |